Healthcare Provider Details

I. General information

NPI: 1295646800
Provider Name (Legal Business Name): BOBBIE MARIE ANDERSON BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 LAWRENCE RD 2060
IMBODEN AR
72434
US

IV. Provider business mailing address

PO BOX 34
IMBODEN AR
72434-0034
US

V. Phone/Fax

Practice location:
  • Phone: 870-202-0832
  • Fax:
Mailing address:
  • Phone: 870-892-0027
  • Fax: 870-892-7945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number120302
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: